Visit to the surgeon on 10/19

[Guest guest]

I've had a CT scan, PRA and SA blood tests twice to confirm. Should

I suggest an adrenal vein study next prior to surgery to confirm the

correct side? Doesn't the CT do this? I will discuss the

laparoscopy and flank surgery, not that I want to have the flank but

I might not have an option. If the laparoscopy doctor has never

performed one of these actual surgeries would you still try it? We

have socialized medicine here so I don't have the option of going to

say, Ottawa. Given the number of cases here I don't have the numbers

behind me like in the states.My options might not be as plentiful

here.

Oh, is it possible that this adenoma could grow back on the other

side? Has this happened to any of you. Thanks for your guidance.

Heidi

[Guest guest]

Golly, Heidi, I wish you could find an experienced laporoscopist.

There are three right here in my neighbourhood! Isn't there some way

of petitioning the procedure based upon risks and common practice in

the literature? The Canadian govt must have a way...

Dr. Grim points out, correctly according to those who practice in this

area fulltime, that only the dexamethasone stimulated comparison of

actual blood flow from the gland is definitive, but that the test is

even more rare and difficult to find than laporoscopy, at least down

here in Calif. The CT and urine, supine & standing comparison

bloodwork with electrolytes can produce evidence but not absolute proof

that any growth is causing HTN. Or low K, and the other problems of

primary hyperalodsteronism. Struggling with this complicated metabolic

Dx myself for over two years, and having had my right adrenal out

without the vein test, I can tell you I wished I did it before surgery.

Why? Because now, although my nuclear CT's do NOT show an adenoma on

the remaining gland, (or any hyperplasia or swelling), my A/R ratio is

still slowly climbing, and I have to take HTN meds, with all those

problems.

The first gland had a growth, but then (1999), that was enough for them

to take it out (with HTN plus the blood and urine tests). Now, doctors

are being more circumspect. The reason I wish I had PROVEN the adenoma

was causing my HTN and low K is that both stayed after the tumored

gland was gone. Now, I have one left, and a climbing A/R ratio. If

that one came out, a shorter and less free life with addison's.

Please ask for proof, and a practiced surgeon should it be sure,

Best,

On Wednesday, October 13, 2004, at 07:09 PM, polishprincessofthenorth

wrote:

>

>

> I've had a CT scan, PRA and SA blood tests twice to confirm. Should

> I suggest an adrenal vein study next prior to surgery to confirm the

> correct side? Doesn't the CT do this? I will discuss the

> laparoscopy and flank surgery, not that I want to have the flank but

> I might not have an option. If the laparoscopy doctor has never

> performed one of these actual surgeries would you still try it? We

> have socialized medicine here so I don't have the option of going to

> say, Ottawa. Given the number of cases here I don't have the numbers

> behind me like in the states.My options might not be as plentiful

> here.

>

> Oh, is it possible that this adenoma could grow back on the other

> side? Has this happened to any of you. Thanks for your guidance.

> Heidi

>

>

>

>

>

>

>

>

[Guest guest]

It is actually using ACTH stimulation before and during the adrenal vein test that improves the ability to tell if it is on one side or both.

We have only been saying this for now lets see about 20 years!

Seems like most other experts how now caught on.

May your pressure be low!

Clarence E. Grim, BS (Chemistry and Mathematics), MS (Biochemistry), MD

Professor of Medicine and Epidemiology

Medical College of Wisconsin

Board certified in Hypertension, Internal Medicine and Geriatrics

[Guest guest]

What you want to know is the bump also making the excess aldo or is it just a lump of fat? The only way to tell this isto have the blood that comes out of the bump assayed to see if it is making too much aldo or just a bump. Be sure they give you ACTH before and during the vein study.

At LEAST 50% of those with a big bump on CT will have little bumpjs on the other side. If the blood coming from the other side is not makingn a lot of aldo then you will likley be improved or likely improved by surgey

Keep ua posted. .

May your pressure be low!

Clarence E. Grim, BS (Chemistry and Mathematics), MS (Biochemistry), MD

Professor of Medicine and Epidemiology

Medical College of Wisconsin

Board certified in Hypertension, Internal Medicine and Geriatrics